FACING UP TO AMPUTATION

Not a jolly subject, especially if you happen to be here on holiday, but my story may help you, or someone close to you, to recognise some warning signs and/or realise that amputation is not the end of life.

My problems began here in Chiangmai during the summer of 1994, working in a ceramics laboratory, making tests on clay samples. I suddenly had a strange numb feeling all over the front of my left thigh. As I stood up, some keys and small change in a trouser pocket touched the numb area. It was such a peculiar, unpleasant sensation that I immediately had to remove them.

This numbness lasted about 10 minutes. A week later the same thing happened - and continued with about the same frequency for the next 6 weeks. Then the same symptoms began to occur on my right thigh, and over the coming months the numbness to both thighs was so frequent that it became part of life. I just ignored it and carried on life as normal. Regrettably, I wished that I had done something at this point!

Eventually, both legs started to become very tired whilst walking and during the ensuing months walking became even more difficult. I came to the stage where a 20 metre walk was an extremely painful experience, necessitating me to stand still for 5 to 10 minutes. Despite being stubborn about medical practitioners - and possibly due to the fact that I had never been really ill - I decided that I should seek medical advice.

I was now approaching 60 years of age and became very much aware of this "slowing down" process due to the leg problems. This was purely physical - mentally I was perfect. But I became terribly irritated with myself as I had always been active, on my feet and loved walking and driving.

Ihad practised as an international ceramic consultant most of my life, spending most time in third world countries, from South and Central America to the Philippines. Never ill, always active, always taking stairs 2 at a time, always fit and well! Finally, I sent a fax to my doctor in England explaining the symptoms and seeking his advice. His response was very blunt, stating that I probably had an arterial occlusion(a coagulation of the blood causing artery blockage, also known as hardening of the arteries) and that I should seek the services of a vascular surgeon - if I could find one in northern Thailand.

Stupidly, I did nothing for about a year, still suffering pain and not wanting to do anything positive, but eventually I relented. At the third hospital I visited I managed to locate Professor Kamphol Laohapensang, the leading vascular surgeon here in Chiangmai at the Maharat Hospital (Suan Dok). He confirmed my English doctor's diagnosis and after undertaking an angiogram test he was able to identify 2 large blockages in both legs. An angiogram consists of a small prick to the main groin artery, no more than a pencil head. A small tube is inserted and the angiogram machine injects a fluid dye under pressure. This dye is forced down the length of the arteries of both legs and immediately an x-ray is taken. This shows where there are any narrow sections or blockages.

Not so lucky

I was admitted to the hospital, 2 by-pass operations took place and upon release I was able to walk again. What a relief! But 3 months later the pains returned and another angiogram resulted in further by-pass operations, caused by severe clotting of the blood. I carried on for another year but 'Lady Luck' was not on my side. A third angiogram was conducted and even more by-pass surgery carried out. In total I made 10 visits to the operating theatre for by-pass surgery and came to know the procedures so well.

I was kept extremely jolly, with no real complaints. The nursing staff and trainee doctors got to know me well and said that I was a model patient! I remember the last time that I came out of the anaesthetic requesting "if I stay here much longer can I come to your Christmas party?" It must be my nature, but I found time to joke about my situation with the staff whose service, I must add, was second to none. Never mind I shall be out of here by next week!

But 3 months later, mid November 2000 to be exact, I was again admitted to hospital with severe leg pains. The surgeon checked the blood flow in both legs with the use of a Doppler ultrasound unit. A small microphone is placed onto the skin above an artery and the unit emits a "whoosh" sound as the heart pumps the blood with every heartbeat. On my left leg and foot I could hear this faint sound but on the right leg there was nothing. In the privacy of my room Ajaan Kamphol and I had what I would call a "discussion" where I asked many questions - and he me gave sound explanations. It transpired that my right leg up to the knee was virtually dead. In fact an ulcer on my right heel had turned gangrenous, which is the death of body tissue.

I must admit that the thought of an amputation had gone through my mind quite frequently in the preceding months. Perhaps, being the type of person that I am (maybe a fatalist but most certainly a realist), it came as no surprise when the surgeon mentioned the impending possibility of a leg amputation. I was cool and calm but obviously deep in my own thoughts.

It was I who then suggested that amputation would be the road to take, rather than further by-pass surgery which, for me, did not appear to be the answer. I noticed that he almost had a look of relief on his face at my decision! Later he explained that when such news is broken, all hell can break loose with screams and wailing, people locking themselves in the bathroom or even running out of the hospital! The surgeon said that it would be necessary to amputate just above my right knee. Following a quick call on his mobile phone he said that we would meet at 8.00am in the operating theatre. So that was it!

Time for reflection

The same evening, in the darkness and quietness of my room, I could not help but think about some of my past activities. I thought of the good and very active life that I had experienced, of walking, swimming, flying light aircraft, playing golf and tennis. I began to see in my mind's eye many things which had previously been forgotten, mainly people with whom I had enjoyed good times and lots of laughter, often being the centre of attention with my silly jokes - of people I would probably never see again. Then thoughts to the future - without a leg! At this point I recall talking light-heartedly to myself. "That's not the end of the world, Bill - you will soon get a tin leg! What if the new leg is too short, or too long? Well, I can always walk with the longer leg in the gutter and the shorter leg on the footpath!"

I wondered - how will I cope with the stress following an amputation? Would it be stress or traumatic? I can imagine someone having a horrendous car accident for example, awaking in hospital to find a limb or limbs missing. That would be a real trauma. Stress, on the other hand, is something everybody has in life, especially if you have a job. How many times have you had to make a critical choice? What about bringing up children? I have a son and daughter - that was stressful on many occasions!

Morning soon came and it was time for the transfer trolley down to the theatre. Theatre? This should be a good show! Onto the operating table, more needles and an oxygen mask, with a "count to 10" command from the lady anaesthetist which I boastfully did in Thai - got up to sarm (3) - then I woke up in the recovery room! It was all over! I cannot describe the thirst at this point - I would have killed for a cold beer! After lots of pleading I eventually got a very small sip of water and an hour later was back in my room where I devoured a litre jug full. Water, that is.

Again talking to myself, I asked why was I not gloomy and depressed - this is the trauma time - but I felt just fine. I felt totally and completely relaxed. I joked a lot with the staff and acquired the nickname "farang baah" which directly translates as "crazy white man". Perhaps subconsciously I had braced myself for this day? Before the amputation I had walked past the other rooms on my floor and some of the sights I saw could not be recorded here. You know the saying "There is always someone worse off than yourself". Looking down my bed and seeing the sheets flat on the right side was a little strange at first but I would soon get accustomed to that sight. 'I shall be going home in a few days with my new tin leg', or so I thought. Along came Christmas and 14 trainee Thai doctors, male and female, came into my room on Christmas morning to sing Christmas carols to me - in English! I could not believe it! What beautiful people.

At this time I was experiencing problems with my left leg. My surgeon had come to visit me every day, including Sunday mornings, when we discussed my progress, so I was fully aware of my situation on a daily basis. A further Doppler ultrasound check proved that there was no blood going to my left foot and this would also have to be amputated. This was fully talked over between the 2 of us and I wholeheartedly requested that this next operation is for a shoe rather than a football boot prosthetic (false limb). In other words, please take off the minimum! Another mobile call down to the operating theatre and it was a "See you again in the morning".

The following day whilst on the operating table, just before going under the anaesthetic, I realised that it was the 31st of December. 'What a way to finish off the year 2000' I thought. Today there was a different anaesthetist - a pretty young thing who asked me to count backwards from a hundred. Out loud in Thai I got down to gow-sip-jet (97) and that was it! Woke up in the recovery room, same story as before. Not so bad I thought, one tin leg and a false shoe - I can cope with that. Should be able to keep my balance - although I may need extra help when leaving The Red Lion on a dark evening!

Next month: yet another operation, back to England and doctors with no bedside manners, then Chiangmai - home and happiness!

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